Hip setting pin



Oct. 3, 1961 w. M. DEYERLE 3,002,514

HIP SETTING PIN Filed Jan. 24, 1958 2 Sheets-Sheet 1 IN VENTOR Oct. 3,1961 w. M. DEYERLE 3,002,514

HIP SETTING PIN Filed Jan. 24, 1958 2 SheetsSheet 2 1N VENTOR mam/110 6116 5% M? W ATTORNEYS ,r 3,0h2,5l4 I E Patented Oct. 3, 1961 3,002,514HIP SETTING PIN William Minor Deyerle, 2222 Monument Ave, Richmond, Va.Filed Jan. 24, 1e58, Ser. No. 711,016 Claims. (Cl. 128-92) The presentinvention relates to methods and attachments for fixation of fracturesin the upper extremity of the femur, slipped epiphyses, and the like.

A number of techniques have been heretofore devised using specialdevices for securing fixation of the upper portions of the femur so asto prevent displacement of the head of the femur relative to the shaft.These are designed for fractures which occur in the head or neck of thefemur or in the intertrochanteric region. For example, theSmith-Peterson nail having three longitudinal and radially projectingfins joined along the longitudinal axis of the nail and inclined at 120to, each other has been devised to provide a measure of fixation of thefracture. The Smith-Peterson nail is designed to be driven into the neckand head of the femur from the outside of the femur shaft at an angle ofapproximately 135 with the axis of the femur shaft. Variousmodifications of the Smith-Peterson nail have also been devised all ofwhich depend solely upon the center nail for fixation. The degree offixation which is available with fixation nails of this type has neverbeen adequate to allow partial or total weight bearing by the fracturepatient until the bone healing was complete, as the torsion resistantand shear resistant forces embodied by the Smith-Peterson nail on thecoacting bone surfaces was inadequate to prevent any slipping orrotation of the neck or head fracture.

In connection with intertrochanteric fractures, it has been proposedthat a thin metal plate be secured to the shaft of the femur below thefracture area by hip screws, and three bone screws fitted in spacedapertures in the plate be threaded into the femur through the neck andinto the head of the bone. The bone screws are designed to be directedalong inwardly converging axes, and, when viewed in side elevation oneof the screws crosses the other two screws in the area of the femurhead. This arraugement was primarily designed only for fractures in theintertrochanteric region, and not in the neck region of the femur, anddoes not act in conjunction with a firm fixation nail such as theSmith-Peterson nail nor does it allow for massive fixation of the headof the femur relative to the shaft.

It has also been proposed to drive several fixation pins of very smalldiameter from the outside of the femur shaft through the neck and headof the femur and into the proximal cortex of the head. This, however,has not been proposed in conjunction with a fixation nail, the fixationpins are merely inserted through the fracture area individually withoutcarefuly defined relation to each other and in no orderly method, andare not attached to anything that secures the fixation at the lateralcortex or outside of the shaft. Further, if any absorption or impactionof the fracture occurs, the points of such fixation pins may be driventhrough the proximal cortex and cartilage sheath on the head of thefemur and produce grating and pain at the hip joint.

In each of the above systems of fixation, the fixation has been suchthat it has been necessary to avoid any weight bearing on the affectedlimb until the bone healing is complete, frequently involving periods ofas long as six months.

The medical profession has long known that weight bearing causingcontact compression at the fracture site, where the bones could bemechanicaly held so as to allow for the contact compression, wasbeneficial in stimulating bone growth. The prior art techniquesdescribed above,

however, involve primarily holding devices only, and weight bearing isdiscouraged for a period of approximately six months. Any inadvertentweight bearing in these types of holding devices could cause disaster.

An object of the present invention, therefore, is the provision of anovel method and means for fixation of bone fractures in weight bearingbones, wherein the disadvantages of the above described prior techniquesare minimized or entirely eliminated.

Another object of the present invention is the provision of a novelmethod and means for fixation of fractures in the upper regions of thefemur, specifically in the neck, head and intertrochanteric regions ofthe femur, for absolutely immobilizing the fracture against shearing andtorsion forces while allowing for absorption at the fracture site andcontact compression exerted by the weight and the muscles of the body.

Another object of the present invention is the provision of a novelmethod and means for fixation of fractures in the upper regions of thefemur which immobilizes the fracture to encourage partial early weightbearing and ambulation of the patient, and thereby stimulate growth ofnew bone and reduce occurrence of nonunion or aseptic necrosis.

Another object of the present invention is the provision of a novelfixation device for fixation of fractures in the upper regions of thefemur, which precisely maintains the fixation elements at the desiredpredetermined angle even under early partial weight bearing whileallowing for relative displacement of the proximal and distal sides ofthe fracture.

Other objects, advantages and capabilities of the pres ent inventionwill become apparent from the following detail description, taken inconjunction with the accompanying drawings illustrating severalpreferred forms of the invention.

In the drawings,

FIGURE 1 is a fragmentary diagrammatic view of the upper portions of afemur having a fracture in the neck thereof, illustrating the manner ofguiding a drill through the lateral cortex in properly oriented relationto the axis of the femur shaft, in accordance with the presentinvention;

FIGURE 2 is a similar diagrammatic view of the fractured femur,illustrating the manner of insertion of the fixation nail in cooperationwith the nail plate, the nail plate being shown in vertical section;

FIGURE 3 is a diagrammatic view illustrating the fixation nail, pins andnail plate in final position on the fractured femur, parts being shownin vertical section and parts in elevation, and the nail plate and pinassembly being slightly modified relative to the form shown in FIGURE 2;

FIGURE 4 is a transverse section view taken along the line 4-4 of FlGURE3;

FIGURE 5 is a perspective view of a modified form of a fixation nail andplate which may be used in practicing the method of the presentinvention;

FIGURE 6 is a diagrammatic view of a fractured femur with another formof fixation, apparatus disposed in final positon on the femur;

FIGURE 7 is a diagrammatic view illustrating the manner of guiding thefixation nail and fixation pins of the form show in FIGURE 6 into thefemur in proper alignment with the femur shaft and with each other;

FIGURE 8 is a transverse section View taken along the line 8-8 of FIGURE7; and

FIGURE 9 is a fragmentary section view taken along the line 9-9 ofFIGURE 8.

The present invention is concerned primarily with the fixation offractures in .the upper regions of the femur.

Referring to the fragmentary illustrations of the femur in FIGURES l, 2,3, 6 and 7 of the drawings, the principal structural features of thisportion of the femur are the shaft 10, the trochanter ill, theconstricted neck 12, which extends along an axis usually inclined atabout 135 to the axis of the shaft 16, and a head 13 which forms oneelement of the hip joint. For purposes of illustration of the specificapplication of the present in vention, it will be assumed that the femurfracture, indicated by the reference character 14, occurs across theconstricted neck 12.

Referring specifically to FIGURES 3 and 4 of the drawings, the fixationassembly, indicated generally by the reference character 15, which ispreferably formed of stainless steel or other metal of suitable strengthadaptable to be placed under the flesh without adverse effects, includesa nail plate 16 which is a vertically elongated body having an enlargedupper or head portion 17, preferably of about one-half inch thickness,and a thin lower or leg portion 18. The nail plate 16, when consideredin transverse section, is slightly concave along the proximal surface 19thereof facing the femur to conform substantially to the curvature ofthe femur shaft 10, and the proximal surface 19 of the nail plate 16when considered in side elevation is substantially straight conformingmore or less to the profile of the outer side or lateral cortex of thefemur shaft 10. The leg portion 18 of the nail plate 16 is provided witha plurality of vertically spaced holes 20 through which hip screws 21may be projected and threaded into the shaft 10 of the femur to securelyanchor the nail plate 16 to the femur shaft.

Extending inwardly from the proximal surface 19 of the nail plate 16into the head portion 17 and along an axis inclined at about 135 to thevertical axis of the nail plate 16 is a cylindrical socket 22terminating within the head portion 17 in an annular shoulder 23 lyingperpendicular to the axis of the socket 22 for-reception of a fixationnail 24 of the Smith-Peterson type or the like. The base of the fixationnail 24 is designed to butt against the annular shoulder 23 and theadjacent surfaces of the nail 2.4 register with the cylindrical surfaceof the socket 22 so as to incline the .nail 24 at the angle ofapproximately 135 to the vertical axis of the nail plate 16. An obviousalternative would be to form the fixation nail 24 integrally with thenail plate 16 locating the nail 24 in the same angular relation to thenail plate 16 as is shown in FIGURE 3. An opening 25 extends toward thedistal surface 26 of the nail plate 16 and communicates with an enlargedbore 27 opening through the distal surface 26 of the nail plate 16. Theopening 25 is designed to receive the threaded shaft of an anchoringbolt 28 to permit the threaded shdt to extend into the threaded socket"in the base of the Smith-Peterson type fixation nail 24 for anchoringthe base of the fixation nail 24 against the annular shoulder 23, thebore 27 being .of sufiicient diameter to accommodate the head of theanchoring bolt 28.

A plurality of holes 29, usually 8, extend through the head portion 17of the nail plate 16 in radially spaced relation to the axis of thesocket 22, the holes 23 being preferably disposed in a square patterncentered on the axis of the socket 22. The holes 29 form guide holesarranged along parallel axes inclined at approximately 135 to thevertical axis of the nail plate 16 and are of a size to just accommodateconventional fixation pins 30, which are usually of about Ms inch orinch diameter, to hold the pins 30 on parallel axes. The fixation pins30 are preferably of the type having threaded shanks adapted to receivetapered tapes 31 thereon.

The form of assembly illustrated in FIGURE 2 is substantially identicalto that illustrated in FIGURE 3, except that the cylindrical socket 22'opening through the proximal surface 19 of the nail plate 16 forreceiving the base of the fixation nail 24 extends continuously throughthe entire thickness of thenail plate 16 to permit rela'e tive axialmovement of the nail 24, the unaltered elements of the modified assembly15' illustrated in FIG- URE 2 being designated by the same referencecharacters applied in connection with FIGURE 3.

A modified form of assembly, designated by the reference character 32;,is illustrated in FEGURE 5. In the modified form of assembly, thefixation nail and nail late are an integral unit, the nail, indicated bythe reference character 3.3, having a cylindrical base portion 34 andthree axially elongated fins 35 inclined at to each other and radiatingfrom the axis of the fixation nail 33. integrally joined to the base ofthe nail 33 is a nail plate portion 36 having a thickened head 37 shapedlike the head portion 17 in FIGURE 3 and a depending leg 38. The head 37is centrally apertured and tapped, as indicated at 39, for connectionwith a driver and is provided with a group of guide holes 40 of a sizeto slidably receive conventional fixation pins 30. The depending leg 38of the nail plate portion 36 is provided with vertically spaced openings41 for hip screws 21 for anchoring the leg 38 to the shaft 10 of thefemur. The axes of the nail 33 and the holes 40 are inclined atapproximately to the plane .of the head 37 and the head 37 arranged inaxial alignment with the leg 33, the axial extent of the holes 40 due tothe thickened nature of the head 37 accurately holds the fixation pinsin the desired pattern and axial alignment.

Still another form is disclosed in FIGURE 6, wherein the fixation nailis removably secured to the nail plate. In this form, the nail plate,indicated by the reference character 42, includes a disk like head 43and a depending leg 44, the head 43 being centrally apertured to receivean anchoring bolt 45 for securing the base of the Smith-Peterson typenail 24 to the head 43 and having holes 46 in the same pattern as isshown in FIGURE 5 for receiving a plurality, for example eight,conventional fixation pins 30. The leg 44 is provided with spacedapertures 46 for receiving bone screws or nails 47 for anchoring thesame to the shaft 10 of the femur.

A director or jig, indicated by the reference character 5% andillustrated in FIGURES l, 7, 8 and 9, is provided to effect orderlyinsertion and precise location and parallelism of the fixation pins 30.The director 50 comprises a cylindrical body 51 having an inner face 52inclined at approximately 135 .to the axis of the cylindrical body 51and an outer face 53 disposed normal to the axis of the cylindrical body51. The body 51 has a central guide bore 54 of slightly over one-halfinch in diameter for slidably accommodating a Smith-Peterson typefixation nail 24, and a plurality of holes 55 of just over one-eighthinch in diameter and spaced radially from the axis of the guide bore 54in parallelism with the axis thereof to form guide openings for thefixation pins 30.

The length of the director 50 along the axis thereof is sufiicient toprovide fixation pin guiding holes 55 of sufficient length to insurethat the fixation pins 30 will be driven in substantial preciseparallelism with each other.

As illustrated in FIGURE 9, the director 50 may also be provided with aremovable obturator sleeve 56 having an inclined inner end 57corresponding to the inclination of the inner face 52 of the director50. The obturator sleeve 56 has an outer diameter correspondingsubstantially to the diameter of the central guide bore 54 of thedirector 5%} to provide a sliding fit therewith, and an inner diametercorresponding substantially to the diameter of a standard threadeddriver shank, or an inner diameter of about %2 of an inch. In the lattercase, a headless threaded screw or shaft, indicated generally at 58,which slidably fits into the obturator sleeve 56 would be employed to bethreaded into the threaded socket at the base of the Smith-Peterson typenail 24. The other ing to maintain the screw or shaft 58 centered in theguide bore 54 of the director 50 to maintain proper control over theaxis along which the fixation nail is driven.

In applying the fixation assembly of the present invention to afractured femur, a one-half inch drill is first drilled into the hardcortical bone at a point between one and one-half inches below thegreater trochanter. Such a drill is schematically illustrated in FIGURE1 and identified by the reference character 60. The drill hole isdesigned to pierce only the hard cortical bone to allow the sharpenedlead edge of the Smith-Peterson type fixation nail 24 to be introducedinto the softer inner portions of the femur. The axis of the drill holemay be conveniently set to the approximately 135 angle of the axis ofthe constricted neck 12 by employing the director or the nail plate 16'as a guide. In such instances, the proximal surface or face of thedirector or nail plate will be disposed against the outer side of thefemur shaft at the proper point below the greater trochanter whereuponthe axis of the guide bore 54 or socket 22' will be approx matelyproperly oriented at the desired angle. The separate Smith-Peterson typefixation nail 24, or the fixation nail, for example 33, integrallyassociated with a nail plate, is then inserted manually into the drillhole and inserted in a fish-tail fashion almost to but not through thefracture site 14. Since the interior of the bone is relatively soft andsponge like, it is possible to manually drive the fixation nail 24beyond the point of maximum penetration of the drill to the desiredpoint of penetration, by means of a driver of the type illustrated inFIGURE 2 and noted by the reference character 61. By inserting thefixation nail in this manner, the hard cortical bone tends to maintainthe fixation nail within the confines of the bone and guide the same tothe proper axis of the penetration.

If the fixation nail is not integral with the nail plate, the nail plateof the type shown at 16 or 16 in FIGURES 3 and 2 should then beassembled onto thenail 24 or the director 50 should be slipped over thebase portion of the nail 24. In the assembly of the nail plate 16 to thenail 24, it is merely necessary to seat the base of the fixation nail 24in the cylindrical socket 22 against the annular shoulder 23 thereof,and thread the anchoring bolt 23 through the bore 27 and into thethreaded socket in the base of the fixation nail 24.

An X-ray is made at this point to determine Whether the positioning ofthe fixation nail is proper. If the position is satisfactory, at leastone and preferably two fixation pins 30 should be inserted with a drillor other driving implement through the guide holes 29 in the nail plates16, 16, or the guide holes 55 in the director 5G, and through theconstricted neck 12, the fracture site 14 and into the hard corticalbone of the head 13. If desired, these first fixation pins may be drivenon through the surface of the head 13 and into the solid pelvic bone.The purpose of driving these first one or two fixation pins 30 beforeprojection of the fixation nail 24 through the fracture site and intothe head 13 is to transfix the head temporarily and prevent separationof the proximal side of the fracture from the distal side when thefixation nail 24 is driven on through the fracture site.

In case the fixation apparatus of the type shown in FIGURES 2 and 3 arebeing used, in which case the nail plate 16 is either bolted to thefixation nail 24 or the plate 16' is slipped onto the base portion ofthe nail, the nail is then driven on through the fracture site and intothe femur head 13 to within one-half to three-quarter of an inch of theproximal cortex of the femur head. The remainder of the fixation pins 3%may then be inserted through the unoccupied holes Zfi of the nail plates16 or 16' to complete the massive fixation of the fracture. Each of thefixation pins 30 is driven as near to the surface of the femur head 13as possible, the leg being wobbled after each fixation pin is insertedfully to be sure that no grating is produced at the joint. The taps 31are then threaded onto the fixation pins 30 until they abut the distalsurface of the nail plate 16 or 16', the taps being provided to preventproximal migration of the pins into the hip joint, and the projectingportions of the fixation pins 30 extending outwardly from the taps 31are sheared ofi.

In the case of the nail and plate unit 32 of the type shown in FIGURE 5wherein the enlarged head 37 is coplanar with the depending leg 38, theguide holes 40 are of sufficient length to effect precise alignment ofthe fixation pins 39 with the fixation nail 24-. If a shallower platewere used providing holes of insufficient length to insure precise pinalignment the director 50 may be butted against the plate with the boreEd in alignment with the tapped opening 39 to guide the pins.

In the case of the fixation assembly illustrated in FIGURES 6 and 7, thedirector 50 is telescopically supported over the projecting base portionof the nail 24 in the manner illustrated in FIGURES 7 and 9 so as toproxide a precise guide for aligning the first one or two fixation pins30 to be inserted through the neck 12 and into the head 13. The fixationnail 24- may then be driven on through the fracture site and into thehead 13 either with the director 5% still fitted on the base portion ofthe nail 24 or with the director 50 removed. In any event, the directormay be properly registered in axial alignment with the fixation nail 24when the nail is driven to its final position within the femurillustrated in FIGURE 6, by means of the threaded screw or shaft 53threaded into the base socket of the fixation nail 24 and the obturatorsleeve 56, which serves as an exposed extension of the fixation nail tomaintain proper alignment of the director 56 therewith. Followinginsertion of the remaining fixation pins 30, the separable nail plate 42may then be fitted onto the fixation pins 30 and bolted onto theprojecting end of the nail 24. The taps 31 may then be threaded onto thefixation pins 30 and the leg of the nail plate 42 anchored to the shaft10 of the femur.

The method and fixation assembly described above provides a massivefixation of the fracture site by the combination of the fixation nailand the centered group of accurately placed, parallel fixation pins 30,all of which are rigidly fixed and maintained in the cortex by the nailplate anchored to the shaft of the femur to maintain the rigidity at theshaft site as well as in the head. This provides sufiicientimmobilization to permit rapid weight hearing by the patient. In each ofthe forms herein shown, wherein the fixation nail 24 is either bolted toor integral with the nail plate, or is axially slidable within thesocket 22' in the case of the nail plate 16, the absolute immobilizationis adequate to resist shearing or torsional forces which would adverselyaffect the reduction of the fracture so as to permit early weightbearing, but allowance is made by absorption and continued contactcompression to stimulate bone growth. in the case of the forms shown inFIGURES 3, 5 and 6 wherein the fixation nail 24 is immovable relative tothe nail plate, the one-half to three-quarters inch clearance betweenthe proximal end of the fixation nail 2d and the surface of the head ofthe femur is sufficient to accommodate absorption and yet maintain theproper angle with the cortex and not allow for any loosening in thedistal cortex. In the case of the form shown in FIGURE 2, slidingfixation is permitted by the sliding coupling of he fixation nail 24 inthe socket 22' of he nail plate 16 to accommodate absorption at thefracture site.

In summary, the apparatus of the present invention affords a means offixation of fractures of the femur which securely fixes up to eightfixation pins in the proximal cortex of the head of the femur andsecurely maintains them in the cortex by a nail plate and fixation nailin one or two piece combinations which attaches to the shaft of thefemur. This maintains the proper angle with the cortex, avoids anyloosening in the distal cortex, and gives absolute immobilizationagainst shearing as well as torsion forces while still allowing forabsorption at the fracture site and continued contact compressionasserted by the weight and muscles of the body, decreasing thepossibility of nonunion and aseptic necrosis and permitting earlyambulation of the patient.

The director 50 is also of particular advantage in connection with bonegrafts. in the case of slipped epiphysis, where it is desirable toaccurately fix the slipped epiphysis at the epiphyseal site rather thanreducing the slipped epiphysis, the director or a nail plate of the typeillustrated in FIGURE 2 may be of definite ad vantage as a guide for thedrill 69 which is required to drill a large hole through the neck 12 ofthe femur and across the epiphyseal line to permit placement of a largecancellous bone graft across this line. Some fixation may be achieved byinserting four to eight fixation pins 3t) into the femur and penetratimthe slipped epiphysis, as guided and precisely positioned by the holes55 or 29 of the director 50 or nail plate 16', respectively. Then, thenail plate 16' or a nail plate of the type indicated at 42 in FIGURE 6may be employed to fix the distal ends of the fixation pins 30.

While several embodiments of the present invention have beenparticularly shown and described, it is apparent that variousmodifications may be made therein without departing from the spirit andscope thereof, and it is desired, therefore, that only such limitationsshall be placed thereon as are imposed by the prior art and are'setforth in the appended claims.

What is claimed is:

1.. An instrument for use in the fixation of fractures in the upperregion of the femur comprising an elongated fixation nail adapted toproject through the distal surface of the femur and the neck of thefemur approximately along the axis of the neck and into the head thereofto a selected distance from the proximal surface of the femur headspacing the end of the nail therefrom sulficiently to accommodateabsorption at the fracture site, said nail having a base to projectoutwardly from the distal surface of the femur, a vertically elongatednail plate having a head portion at the upper end thereof adjacent saidbase of said nail and a depending leg portion to be fixedly mounted onthe distal surface of the femur shaft immediately below the trochanter,said nail being held by said nail plate against displacement from a preselected angular relation to the vertical axis of said nail plate tomaintain a selected angle between the nail and the femur shaft, saidhead portion having a plurality of holes extending along axes parallelto and spaced symmetrically radially of the nail axis, and a pluralityof fixation pins slidably extending through said holes to projectinwardly of said nail plate through the neck of the femur and terminatein the proximal cortex of the femur head, said fixation pins beingslidably held by the bounding surfaces of said holes to resist angulardisplacement of the fixation pins in the distal cortex from axesparalleling said nail axis, whereby said nail, nail plate and fixationpins coact to provide massive fixation of the fracture immobilizing thefracture against shearing and torsion forces while accommodatingabsorption at the fracture site and contact compression thereon.

H 2. An instrument for use in the fixation of fractures in the neck ofthe femur and adjoining regions comprising an elongated fixation nail ofthe type having a plurality of longitudinal and radial fins adapted tobe projected through the distal lat ral cortex of the femur and the neckof the femur approximately along the axis of the neck to space the innerend of the nail a selected dis tance from the proximal surface of thefemur head, said nail having a cylindrical base portion to projectoutward- Iyfrom the distal lateral cortex of the femur, a verticallyelon ated nail plate having a thickened head portion at the upper endthereof adjacent said base of said fixation nail and a depending legportion to be fixedly anchored to the distal lateral cortex of the femurshaft immediately below the trochanter and intimately abutting thelateral cortex over a substantial vertical extent, said nail being heldby said nail plate against angular displacement from a preselectedangular relation to the vertical axis said nail plate to maintain aselected angle between the nail and the femur shaft, said thickened headportion having a plurality of guide holes extending therethrough andlying in a regular geometric path centered on said nail axis, and aplurality of fixation pins slidably supported for axial movement in saidholes to project inwardly of said nail plate through the neck of thefemur and terminate in the proximal cortex of the femur head, the axiallength of said guide holes being several times the diameter of saidfixation pins said fixation pins being held by the bounding surfaces ofsaid holes on parallel axes paralleling the fixation nail by thebounding walls of said guide holes to resist angular displacement of thefix Ion pins in the distal lateral cortex and being free to slideaxially within said holes to accommodate absorp tion at the fracturesite and contact compression thereon.

3. An instrument for use in the fixation of fractures in the neck of thefemur and adjacent regions comprising an elongated fixation nail adaptedto project through the distal lateral cortex of the femur and the neckof the femur approximately along the axis thereof and into the head ofthe femur, said fixation nail having a plurality of longitudinal andradial fins to be disposed within the femur and. a cylindrical baseportion to project outwardly from the distal lateral cortex of the femurhaving a threaded central opening therein opening through the base wallof the nail, a vertically elongated nail plate hav' ing a thickened headportion at the upper end thereof and a depending leg portion to beanchored to the distal latteral cortex of the femur shaft immediatelybelow the trochanter, said head portion of said plate having a boreextending entirely therethrough along an axis inclined at a selectedangle to the vertical axis of the nail plate corresponding substantiallyto the angular relation between the axes of the femur neck and shaft andcomplementing the cross-section of the base of said nail slidablyreceiving the base of said nail therein with the surface of said boreholding the same at said selected angle, said head portion having aplurality of diametrically spaced pairs of guide holes extendingtherethrough along axes parallel to and spaced symmetrically relativelyto the axis of said bore, a plurality of fixation pins slidablysupported in said guide holes to project inwardly of said nail plate,through the neck of the femur and terminate in the proximal cortex ofthe femur head, the axial length of said guide holes being several timesthe diameter of said fixation pins said fixation pins being held by thebounding walls of said guide holes to resist angular displace-' ment ofthe fixation pins in the distal lateral cortex and being slidablysupported for axial displacement, whereby said nail, nail plate andfixation pins coact to provide massive fixation of the fractureimmobilizing the fracture against shearing and torsion forces while thenail plate accommodates relative axial displacement of said nail andfixation pins in response to absorption at the fracture site and contactcompression thereon.

4. An instrument for use in the fixation of fractures in the neck of thefemur and adjacent regions comprising an elongated fixation nail adaptedto project through the distal lateral cortex of the femur and the neckof the femur approximately along the axis thereof and into the head ofthe femur, said fixation nail having a plurality of longitudinal andradial fins to be disposed within the femur and a cylindrical baseportion to project outwardly from the distal lateral cortex of the femurhaving a threaded central opening therein opening through the base wallof the nail, a vertically elongated nail plate 9 having a thickened headportion at the upper end thereof and a depending leg portion to beanchored to the distal lateral cortex of the femur shaft immediatelybelow the trochanter, said head portion of said plate having a socketforming a seat for the base of said nail extending through the facethereof adjacent the femur along an axis inclined at a selected angle tothe vertical axis of the nail plate and a bore opening through theopposite face of the plate in axial alignment with said socket and anannular constriction between said bore and said socket having an openingcommunicating said bore with said socket, a threaded bolt extendingthrough said bore and said last-mentioned opening and into said threadedopening in said nail fixing said nail to said plate, said head portionhaving a plurality of diametrically spaced pairs of guide holesextending therethrough along axes parallel to and spaced symmetricallyrelative to the axis of said bore, a plurality of fixation pins slidablysupported in said guide holes to project inwardly of said nail platethrough the neck of the femur and terminate in the proximal cortex ofthe femur head, said fixation pins being held by the bounding walls ofsaid guide holes to resist angular displacement of the fixation pins inthe distal lateral cortex and being slidably supported for axialdisplacement, whereby said nail, nail plate and fixation pins coact toprovide massive fixation of the fracture immobilizing the fractureagainst shearing and torsion forces while the nail plate accommodatesrelative axial displacement of said nail and fixation pins in responseto absorption at the fracture site and contact compression thereon.

'5. An instrument for use in the fixation of fractures in the neck ofthe femur and adjacent regions comprising an elongated fixation nailadapted to project through the distal lateral cortex of the femur andthe neck of the femur approximately along the axis thereof and into thehead of the femur, said fixation nail having a plurality of longitudinaland radial fins to be disposed within the femur and a cylindrical baseportion to project outwardly from the lateral distal cortex of thefemur, a vertically elongated nail plate having a thickened head portionat the upper end thereof integrally joined to the base of said nail anda depending leg portion to be anchored to the distal lateral cortex ofthe femur shaft immediately below the trochanter, the axis of said nailbeing inclined to the vertical axis of said nail plate at a selectedangle corresponding substantially to the angular relation between theaxes of the femur neck and shaft, said head portion having a pluralityof guide holes extending therethrough and lying in a regular geometricpath centered on said nail axis, said guide holes extending along axesparallel to and spaced in symmetrically arranged pairs relative to theaxis of said nail, and a plurality of fixation pins slidably supportedin each of said guide holes to project inwardly of said nail platethrough the neck of the femur and terminate in the proximal cortex ofthe femur head, said fixation pins being held by the bounding walls ofsaid guide holes to resist angular displacement of the fixation pins inthe distal lateral cortex and being free to slide axially within saidholes to accommodate absorption at the fracture site and contactcompression thereon.

6. The combination recited in claim 2, wherein there are eight of saidguide holes and said eight guide holes are arranged in a square patterncentered upon the axis of said nail, and one of said fixation pins islocated in each of said guide holes.

7. The combination recited in claim 3, wherein there are eight of saidguide holes and said eight guide holes are arranged in a square patterncentered upon the axis of said nail, and one of said fixation pins islocated in each of said guide holes.

8. The combination recited in claim 4, wherein there are eight of saidguide holes and said eight guide holes are arranged in a square patterncentered upon the axis aooasis 10 of said nail, and one of said fixationpins 'is located in each of said guide holes.

9. An instrument for use in the fixation of fractures in the neck of thefemur and adjacent regions comprising an elongated fixation nail adaptedto project through the distal lateral cortex of the femur and the neckof the femur approximately along the axis thereof and into the head ofthe femur, said fixation nail having a plurality of longitudinal andradial fins to be disposed within the femur and a cylindrical baseportion to project outwardly from the lateral distal cortex of thefemur, a vertically elongated nail plate having a thickened head portionat the upper end thereof integrally joined to the base of said nail anda depending leg portion to be anchored to the distal lateral cortex ofthe femur shaft immediately below the trochanter, the axis of said nailbeing inclined to the vertical axis of said nail plate at a selectedangle corresponding substantially to the angular relation between theaxes of the femur neck and shaft, said head portion having eight guideholes extending therethrough and arranged in a square pattern centeredon said nail axis, said guide holes extending along axes parallel to andspaced in symmetrically arranged pairs relative to the axis of saidnail, and a fixation pin slidably supported in each of said guide holesto project inwardly of said nail plate through the neck of the femur andterminate in the proximal cortex of the femur head, said fixation pinsbeing held against angular displacement in the distal lateral cortex bythe bounding walls of said guide holes and being free to slide axiallywithin said holes to accommodate absorption at the fracture site andcontact compression thereon.

10. An instrument for use in the fixation of fractures in the neck ofthe femur and adjacent regions comprising a vertically elongatedanchoring plate having a thickened head portion at the upper end thereofof substantially rectangular configuration and a depending leg portionto be fixedly mounted on the distal lateral cortex of the femur shaftimmediately below the trochanter, said head and leg portions having acontinuous concave cylindrical surface portion adapted to substantiallyconform to and abut the lateral cortex over a substantial verticalextent, said head portion having a substantially centrally located boreextending entirely therethrough along an axis inclined at a selectedangle to the vertical axis of the anchoring plate correspondingsubstantially to the angular relation between the axes of the femur neckand shaft and eight guide holes arranged in a square patternsubstantially centered on said head portion, said guide holes extendingalong axes parallel to and spaced in symmetrically arranged pairsrelative to the center of said head portion, a plurality of fixationpins slidably supported in at least the majority of said guide holes toprojeot inwardly of said anchoring plate through the neck of the femurand terminate in the proximal cortex of the femur head, the squarepattern of guide holes including two transversely spaced rows of guideholes spaced apart a distance corresponding substantially to the radiusof a femur neck, said head portion being of sufiicient thickness so thatthe axial length of said guide holes is several times the diameter ofone of said fixation pins, and said fixation pins being held by thebounding walls of said guide holes to resist angular displacement ofsaid fixation pins in the distal lateral cortex and being slidablysupported for axial displacement to accommodate absorption at thefracture site and contact compression thereon whereby the anchoringplate and fixation pins coaot to provide massive fixation of thefracture immobilizing the fracture against shearing and torsion forceswhile the anchoring plate accommodates relative axial displacement ofthe fixation pins in response to absorption and contact compression.

(References on following page) V 11 Refsxenus Cited in. the file of thispatent UNITED STATES PATENTS Friddle Ian.23,1940

Longfellow Jan. 28, 1947 5 McKibbon Mar. 14, 1950 Lorenzo Oct. 24, 195095-658 '12, Longfellow -b Jan. 9, 1951 Bambara et a1. Nov. 29, 19.55Pohl Dec. 4, 1956 FOREIGN PATENTS I Sweden May 9, 1939

